Perspectives of exercise in kidney transplant recipients

Dr Lettie Bishop
Loughborough University
Patient and Public Involvement

Summary

We are just starting a 3 year study (funded by Heart Research UK) looking at the feasibility of different exercise programmes for people who have had a kidney transplant. The primary aim of this project is to evaluate the recruitment, retention and feasibility of 3 different 8 week exercise programmes of moderate continuous and higher intensity interval exercise in renal transplant recipients to ensure that the design of a subsequent exercise intervention RCT has maximum reach and benefit.

We work in partnership with patients to ensure that our research addresses issues that are important to them, in ways that are acceptable and meaningful to the user group. In order to design such studies, the key concepts and designs are very much driven by patient demand for information and advice about safe and effective exercise after kidney transplantation. In our recent PPI work patients told us that they want to become active in an enjoyable way, but they're not sure how much and what type of exercise would be best for them and they are worried about ‘overdoing it’ or damaging their new kidney. Issues raised during these focus groups were fundamental to the design of this study. We now need to continue this by finding out the patients’ perspectives on the feasibility, acceptability and perceived worth of the study exercise programmes – and also how best to disseminate study outcomes to kidney transplant recipients.

Therefore, the primary focus of this case study, in support of the larger funded study, is both research development and educational development through the involvement of kidney transplant recipients in research design and subsequently the best way to disseminate research outcomes through educational development.

What are the Aims?

Adequate, patient-centred feasibility testing is vital to ensure the design of a viable future RCT to establish real-life efficacy in the target population. The aim of this PPI work is to support the generation exercise programmes that have wide appeal and good adherence in order to maximise reach and benefit.

What has changed/will change?

At this stage this is hard to assess. There is an urgent priority need for research to provide evidence-based exercise guidance for transplant recipients to support the benefits of exercise training to reduce cardiovascular events. Exercise is recommended in NICE guidelines for management of cardiovascular and kidney disease, but incorporation into rehabilitation of those who have received a kidney transplant is lacking. Patient perspectives are fundamental part of the process to produce an innovative evidence-based intervention ready for evaluation in a subsequent clinical trial, ahead of implementation.

What lessons have we learnt?

This is the focus of the PPI in this case and their views will be a fundamental part of the evaluation of the exercise programmes. These will have great impact as they will play a crucial part in the design of the RCT.